23D1104227 CLIA NUMBER - USCG DETROIT

Laboratory Demographics

  • CLIA Code: 23D1104227
  • Facility Name: USCG DETROIT
  • Facility Address: 43401 N JEFFERSON AVE BLDG 825
    SELFRIDGE A N G B, MI
    ZIP 48045
  • Facility Phone: 586 239-5017
  • Facility Type: Other - MILITARY TREATMENT
  • Facility Type: Waiver
  • Lab Director: CAPT KEVIN NOLAN
  • NPI Number: 1801550843
  • Taxonomy: 332000000X - Military/U.S. Coast Guard Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D1104227
LAB Type Other - MILITARY TREATMENT
Facility Name USCG DETROIT
Street 43401 N JEFFERSON AVE BLDG 825
City SELFRIDGE A N G B
State MI
ZIP 48045
Phone 586 239-5017
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2025
Certificate Expiration Date 8/26/2027
Facility Type Other - MILITARY TREATMENT
Lab Director CAPT KEVIN NOLAN

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This page was last updated on: 9/29/2025